Der Anaesthesist
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The increasing mechanisation, specialisation and sub-specialisation in medicine have enduringly supported the delegation of originally medical activities to non-medical personnel and sometimes also made it necessary. Economical considerations have recently given additional impulse to these developments. ⋯ The following article justifies from professional and legal viewpoints why anaesthesia also belongs to the genuine medical duties and is reserved exclusively for medical personnel. Therefore, the correct performance of parallel narcosis is coupled with far-reaching liability risks for all participants involved in this form of organisation or those responsible for them.
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Up to 90% of all percutaneous coronary interventions include coronary artery stenting. Dual antiplatelet therapy, usually involving acetylsalicyl acid combined with clopidogrel, is mandatory for patients with coronary artery stents. The duration of antiplatelet therapy for bare metal stents is 3-4 weeks, for drug eluting stents 6-12 months. ⋯ In cases of high thrombosis risk, at least the acetylsalicyl acid should be continued until the day of surgery. For patients under antiplatelet therapy scheduled for local anaesthesia, national recommendations exist. A close collaboration between the anaesthesiologist, cardiologist and surgeon is essential for appropriate pre-, intra- and postoperative management.
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Development of a two-buffer model which simulates the acid-base properties of blood and allows comparison of the different acidbase concepts according to Stewart and to Siggaard-Andersen. ⋯ Despite controversial discussions, both concepts are much closer than might be expected. Whereas in the Stewart approach the focus of analysis is on plasma, with the Siggaard-Andersen approach it is on blood. Hence, a combined analysis of the blood gases (pH, pCO(2), pO(2), sO(2), cHb, BE) and of the strong ion gap (SIG) may be useful.
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Osmotherapy, i.e. the intravenous administration of hyperosmolar solutions, is one of the mainstays of therapy for reduction of a pathologically increased intracranial pressure, in addition to analgosedation and raising the upper body of the patient. The administration of mannitol as a osmotherapeutic agent is, however, marred by considerable side-effects. A possible alternative is the use of hypertonic saline solution (NaCl). The advantages and disadvantages of this option are considered as well as points still in question.
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Randomized Controlled Trial Comparative Study
[Spinal anaesthesia in day-case surgery. Optimisation of procedures].
Since prilocaine is being increasingly used for day case surgery as a short acting local anaesthetic for spinal anaesthesia and because of its low risk for transient neurological symptoms, we compared it to bupivacaine. ⋯ Under the present study conditions, hyperbaric prilocaine 2% was superior to hyperbaric bupivacaine 0.5% due to a shorter effect profile but otherwise equivalent quality of block. However, puncture in a sitting position and positioning with elevated torso for restriction of the cranial expansion of block spread might cause an enhanced sacral block with delayed recovery of bladder function.